Provider Demographics
NPI:1790818813
Name:SAUK COUNTY
Entity Type:Organization
Organization Name:SAUK COUNTY
Other - Org Name:SAUK COUNTY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-524-7507
Mailing Address - Street 1:1051 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-2321
Mailing Address - Country:US
Mailing Address - Phone:608-524-7513
Mailing Address - Fax:608-355-4309
Practice Address - Street 1:1051 CLARK ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2321
Practice Address - Country:US
Practice Address - Phone:608-524-7513
Practice Address - Fax:608-355-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41520200Medicaid
WI41520200Medicaid
WI000527045Medicare ID - Type UnspecifiedHOME CARE